Provider Demographics
NPI:1902627045
Name:JOHNSON, TIFFANY ROCHELLE (RN CASE MANAGER)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROCHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN CASE MANAGER
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ROCHELLE
Other - Last Name:JOYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3003 CRUSADES ST
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 NNPTC CIR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-6314
Practice Address - Country:US
Practice Address - Phone:843-794-6371
Practice Address - Fax:843-794-6885
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1141881163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management